Winterblast 2026 Registration Form

Participant's Information

Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade*

Gender*

MaleFemale

Participant's Phone Number*

Area CodePhone Number

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

T-Shirt Size*

NOTE: T-Shirts will not be given at every event.

Parent/Guardian Information

Parent's/Guardian's Name*

First NameLast Name

Home Number

Area CodePhone Number

Cell Number*

Area CodePhone Number

Parent's/Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is your child prescribed any medication? If yes, please explain any instructions.*

Liability Agreement and Parental Consent

I hereby give my approval for my child’s participation in any and all activities prepared by The Federated Church during the Winterblast retreat. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Federated Church and all its respective staff and volunteers from any and all liability for injuries to said child arising out of participating in selected retreat activities. In the event the staff are unable to reach me, I give the staff permission for treatment as deemed necessary. Insurance is considered to be the personal responsibility of the retreat participant.

The $25 registration fee can be paid by cash or check by bringing the money to the Federated Church during regular business hours (8:30-4 Mon-Fri), on a Sunday morning between church services, or during our Journey youth group on Wednesday nights (6:30-8:30 pm). Do you agree to pay the $25 registration fee by the February 10th deadline?*

Yes, I agree

Would the student be interested in volunteering during The Federated Church's Outdoor Expo (January 30 & 31) to earn money toward their Winterblast registration?*

YesNo

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

WINTERBLAST 2026